Cardiac CT and MR for Adult Congenital Heart Disease

735 Pages·2014·67 MB·English

by  Matthias Greutmann MD

Farhood Saremi Editor
Cardiac CT and MR
for Adult Congenital
Heart Disease
123
Cardiac CT and MR for Adult Congenital
Heart Disease

Farhood Saremi
Editor
Cardiac CT and MR
for Adult Congenital
Heart Disease
Editor
Farhood Saremi , MD
Department of Radiology
Cardiothoracic Section
University of Southern California
USC Keck Hospital
Los Angeles, CA
USA
ISBN 978-1-4614-8874-3 ISBN 978-1-4614-8875-0 (eBook)
DOI 10.1007/978-1-4614-8875-0
Springer New York Heidelberg Dordrecht London
Library of Congress Control Number: 2013955011
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Pref ace
Different classifi cations for congenital heart diseases (CHD) have been intro-
duced. These classifi cations have been mainly based on data obtained from
cadaveric and surgical specimens and are designed to simplify the under-
standing of complexity of this group of abnormalities. However, until recently
no single imaging modality has been capable of demonstrating the full spec-
trum of abnormalities in complex cardiac malformations. In the past years,
although plain radiographs, angiography, and echocardiography have been
able to answer many questions and guide clinicians and surgeons to treat the
patients, in complex cases the shortcomings of these techniques are quite
sensible. New generations of MR and CT have facilitated understanding of
these complex cases before and after surgical corrections. In fact, the clinical
application of CT and MRI has grown dramatically, and cardiologists and
cardiothoracic surgeons are ordering these diagnostic modalities more than
before.
Along with the advances in diagnostic techniques, the number of adults
with CHD has increased over the past decades thanks to parallel advances in
surgical techniques and perioperative care. This group of patients comprises
important referral cases to hospitals for diagnosis of residual or recurrent
lesions requiring serial imaging studies to select candidates for reoperation.
In many cases, particularly in immigrants, physicians frequently face compli-
cated CHDs while no clear past history of the disease or the type of surgical
treatment can be found. In these cases, a good diagnostic image speaks a
thousand words. Images provided by CT and MR can bring a great amount of
diagnostic data in these patients with complicated malformations. The ele-
ment that binds these two modalities in the diagnosis and imaging workup of
CHD is their systematic approach to evaluating cardiac anatomy and func-
tion. When it comes to the assessment of anatomy, there is no imaging modal-
ity that can compete with the speed, accuracy, and spatial resolution of new
CT scanners in demonstration of the complex structure of the heart and
related vasculature. New generation CT scans can cover the entire anatomic
span of the heart and major vessels in a few seconds with spatial resolution of
less than 0.5 mm3 . The availability of new low-radiation techniques has made
CT an even more attractive choice in many studies. MR is complementary to
CT and provides high-resolution anatomic detail in any plane as well as phys-
iologic data that would otherwise be diffi cult to obtain or unobtainable by
either echo or catheterization. Recent technological improvements in MRI
v
vi Preface
hardware and imaging techniques have resulted in dramatic changes to over-
come previous limitations of cardiac MR. This is particularly true for imag-
ing of patients with CHD, who are often younger and frequently require
continued, lifelong imaging follow-up. Routine availability of high-fi eld
magnets, parallel imaging techniques, 2D and 3D steady-state free precession
sequences, and high-speed time-resolved MR angiography have opened new
gates for cardiac research and improved the evaluation of cardiac pathologies.
Time- resolved contrast-enhanced MR angiography with sub-second tempo-
ral resolution provides additional dynamic information on blood fl ow that is
less apparent or absent on static MR angiography acquisitions. Newer tech-
niques such as 3D and 4D volumetric fl ow analyses have facilitated the analy-
sis of shunt fl ow and post-Fontan hemodynamics. In addition to quantifying
the velocity or volume of blood fl ow through any number of structures of
interest, the three-directional fl ow information acquired with 4D fl ow MR
can be used to qualitatively assess changes in the complex fl ow patterns
within the heart or vasculature.
This book is prepared to serve students, clinicians, and surgeons in the
skillful implementation of cardiac MR and CT techniques, coupled with
offering a substantial fraction of the existing literature that can be used as a
comprehensive resource for CT and MR imaging of CHD. The basics of CT
and MR techniques are discussed in the fi rst few chapters in this book. Other
chapters focus on common congenital heart problems in adults. The book
contains many intriguing cross-sectional and post-processed images that pro-
vide an elegant outfi t to the content of the book and assist the reader in quickly
and easily recognizing various pathologies. Finally, the job would have
remained incomplete without the unreserved assistance of Margaret Burns,
Developmental Editor; Andy Moyer, Editor; and Wendy Vetter and Wieslawa
Langenfeld, the illustrators.
Los Angeles, CA Farhood Saremi, MD
Contents
1 Classifi cation and Epidemiology . . . . . . . . . . . . . . . . . . . . . . . . 1
Matthias Greutmann and Daniel Tobler
2 Embryology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Hiroyuki Yamagishi and Chihiro Yamagishi
3 Cardiac MRI Examination: An Overview . . . . . . . . . . . . . . . . 23
Michael J. Campbell
4 Magnetic Resonance Angiography . . . . . . . . . . . . . . . . . . . . . . 55
Christopher J. François
5 Principles of CT Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Sebastian Leschka, Stephan Waelti, and Simon Wildermuth
6 Echocardiographic Imaging in Adult Congenital
Heart Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Jon Detterich, Andrew Yoon, and Philip Chang
7 Right Ventricle Outfl ow Tract . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Farhood Saremi, Siew Yen Ho, and Damián Sánchez-Quintana
8 Left Ventricular Outfl ow Tract . . . . . . . . . . . . . . . . . . . . . . . . . 173
Stefan Buchner and Kurt Debl
9 Repaired Tetralogy of Fallot . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
Ee Ling Heng and Sonya V. Babu-Narayan
10 Transposition of the Great Arteries . . . . . . . . . . . . . . . . . . . . . 225
Farhood Saremi
11 Univentricular Heart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
François-Pierre Mongeon, François Marcotte, and Paul Khairy
12 Visceroatrial Situs in Congenital Heart Disease . . . . . . . . . . . 285
Marinos Kontzialis, Hugo Spindola-Franco,
and Linda B. Haramati
13 Cardiac Shunts: ASD, VSD, PDA . . . . . . . . . . . . . . . . . . . . . . . 305
Farhood Saremi
vii
viii Contents
14 Atrioventricular Septal Defects . . . . . . . . . . . . . . . . . . . . . . . . . 347
Nilda Espinola-Zavaleta, Luis Muñoz-Castellanos,
and Aloha Meave-Gonzalez
15 Ebstein Anomaly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361
Daniel Tobler, Laura Jimenez Juan, Andrew M. Crean,
and Rachel M. Wald
16 Hypertrophic Cardiomyopathy . . . . . . . . . . . . . . . . . . . . . . . . . 373
Raymond H.M. Chan and Martin S. Maron
17 The Right Myocardium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399
Fumiko Kimura and Nobuhisa Hagiwara
18 CT in Pediatric Congenital Heart Disease . . . . . . . . . . . . . . . . 411
Hyun Woo Goo
19 Surgical Considerations in Adult Patients with Congenital
Heart Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431
Sameh M. Said, Harold M. Burkhart, and Joseph A. Dearani
20 MRI in Repaired Congenital Heart Disease . . . . . . . . . . . . . . . 451
Julia Geiger and Michael Markl
21 Cardiac CT and MR Evaluation of the Adult
Fontan Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 481
Tiffanie R. Johnson, Margaret M. Samyn, and Laureen Sena
22 Transcatheter Interventions in Adult Congenital
Heart Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 499
Damien Kenny, John Hibbeln, and Ziyad M. Hijazi
23 Virtual Surgery in Congenital Heart Disease . . . . . . . . . . . . . . 515
Thomas Sangild Sørensen, Jesper Mosegaard,
Stefan Kislinskiy, and Gerald F. Greil
24 Aortic Arch Anomalies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 525
Scott DeRoo, Jonathan R. Dillman, Philip Cascade,
Richard G. Ohye, and Baskaran Sundaram
25 Pulmonary Hypertension in Congenital Heart Disease . . . . . . 553
William M. Bradlow, Sonya V. Babu-Narayan,
and Raad H. Mohiaddin
26 Congenital Thoracic Venous Anomalies . . . . . . . . . . . . . . . . . . 573
Farhood Saremi
27 Coronary Artery Anomalies . . . . . . . . . . . . . . . . . . . . . . . . . . . 603
Monvadi B. Srichai and Derek Mason
28 Coronary Veins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 635
Farhood Saremi, Horia Muresian, and Damián Sánchez-Quintana
29 Congenital Pericardial Anomalies . . . . . . . . . . . . . . . . . . . . . . . 667
Farhood Saremi
Contents ix
30 Extracardiac Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . 679
Farhood Saremi
31 Cardiac MR in Patients with Implantable
Arrhythmia Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 701
Roy Beinart and Saman Nazarian
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 709